8%.[5] Specific epidemiological data on AKI in New Zealand is lacking. We recommend using the KDIGO definition to define and to stage functional change in AKI (Table A2). (refer to KDIGO guideline) We

recommend that all causes of AKI including contrast-induced-AKI be defined using the same criteria as other causes of AKI. (1D) We recommend that the cause of AKI be defined as soon as possible after diagnosis of AKI. (1D) selleck chemicals Biomarkers of kidney cellular damage should be incorporated into the AKI definition when sufficient cut-offs are available for each biomarker in the context of renal injury. Functional parameters in addition to structural parameters (determined by elevated biomarkers of structural damage) should be considered in determining the diagnosis, prognosis and outcome of AKI. Fluids In the absence of haemorrhagic shock, we suggest using isotonic crystalloids rather than colloids for volume resuscitation. (2B) We recommend against using hydroxyethyl Tanespimycin clinical trial starch (HES) solutions for volume resuscitation. (1B) Protocolized haemodynamic management We suggest using protocol based management of hemodynamic and oxygenation parameters to prevent development or worsening of AKI in high risk patients in the perioperative setting (2C) or in patients with septic shock (2C). Glycaemic control and micronutrient intake in critical illness: Renal effects and outcomes We recommend against using Insulin to target a plasma glucose of less than

6.1 mmol/L. (1B) We suggest using Insulin to treat hyperglycaemia if the plasma glucose is more than 10.0 mmol/L. (2C) Once treatment has started we suggest targeting a plasma glucose between 8.0 and 10.0 mmol/L. (2C) We recommend ensuring micronutrient intake is adequate and losses caused by RRT are replaced. (1C) Prevention of aminoglycoside induced AKI a. After initial therapy with aminoglycoside

antibiotics, we suggest using less nephrotoxic therapeutic alternatives when available and still appropriate. (2B) We suggest considering both the potential advantages of early aminoglycoside therapy and the limited early risk of aminoglycoside nephrotoxicity when choosing an agent for the initial MycoClean Mycoplasma Removal Kit treatment of infections where aminoglycoside sensitive organisms may be responsible. We recommend using either iso-osmolar or low-osmolar iodinated contrast media, rather than high-osmolar iodinated contrast media, in patients at increased risk of CI-AKI. (1B) Since iohexol use as an intra-arterial injection in patients with pre-existing renal impairment is associated with an increase in CI-AKI risk when compared to iodixanol, we suggest avoiding iohexol use in this high risk setting. (1B) We recommend IV volume expansion with isotonic saline or sodium bicarbonate, rather than no IV volume expansion, in patients at increased risk for CI-AKI. (1A) We suggest that isotonic sodium bicarbonate for IV volume expansion is at least equivalent to isotonic sodium chloride in prevention of CI-AKI.